Breathe Easy

by Jennifer Pirtle

Dan Houston, 49, occasionally suffered from hay fever, yet his allergies never affected his ability to run. That changed in July 2004 when he began having trouble breathing during a routine six-miler. "My lungs felt like I was inhaling very cold air in the middle of winter," says Houston, a department manager for a machinery manufacturer in York County, South Carolina. Houston struggled to run that summer and the next. "It was hard to justify taking medication just so I could run," he says. "But finally I decided that exercise was important enough to me to seek help."

Houston's doctor diagnosed him with exercise-induced asthma (EIA), a condition in which exercise triggers coughing, wheezing, shortness of breath, and chest tightness. (Chronic asthma is a more serious affliction.) Today, Houston takes two puffs from his inhaler about 10 minutes before he works out and can, on most days, run without gasping.

EIA and hay fever (or allergic rhinitis) are the two most common respiratory conditions that affect runners, and they often go undiag-nosed and untreated. But as Houston found, it only takes a little effort to manage your symptoms so they don't slow you down. Although allergies and asthma are separate conditions, they often go hand-in-hand. Everett Murphy, M.D., a pulmonologist in Olathe, Kansas, says about 20 to 40 percent of his patients with EIA have some form of allergies.

Allergies occur when the immune system overreacts to substances that are harmless in most people. “In these individuals, the body produces IgE antibodies to the allergen," says Marjorie Slankard, M.D., a clinical professor of medicine at Columbia University and codirector of the allergy clinic at Columbia/Eastside Hospital in New York City. "Those antibodies then cause certain cells to release histamines and other chemicals, including leukotrienes." Histamines are the bane of allergy-sufferers' existence, causing symptoms that range from a runny nose and itchy eyes to difficulty breathing.

When we breathe, air travels through the nose or mouth, through the windpipe into two main air passages called the bronchial tubes, then into tiny airways in the lungs. For most of us, this process is effortless. But if you have asthma, those airways become inflamed and swollen, making breathing difficult and the passages overly sensitive to allergens (trees and grass) and irritants (smoke, dust mites, and indoor molds).

So what makes exercise a trigger? One theory is that those with EIA are overly sensitive to the temperature and humidity of the inhaled air. Also, during exercise, you're inhaling more air per breath than when you're sedentary. "When a runner increases his breathing rate and depth, the cooling and drying of the airway seems to trigger the EIA response," says Dr. Murphy.

Interestingly, studies have shown that following most EIA attacks, there's up to a two-hour period during which exercise won't spur another attack. So those who can manage to run through the initial onslaught of symptoms can finish their runs in peace. Many cases of EIA go undiagnosed because the tell-tale symptom--consistent coughing during or after exercise--seems common, according to William Briner, Jr., M.D., medical director for the sports-medicine center at Advocate Lutheran General Hospital in Park Ridge, Illinois. Most EIA attacks will occur three to eight minutes into a bout of exercise, although the timing can vary. Also, many adults rule it out, assuming that the condition would've shown itself during their childhood. But asthma can develop at any age. The same goes for allergies, which are often mistaken for a never-ending cold. If your sniffling and sneezing goes on for more than a month, allergies could be to blame.

Allergy sufferers can benefit from an antihistamine containing long-lasting and nonsedating loratadine. Immunotherapy, in which small amounts of an allergen are injected to help your body become less susceptible to allergies, can also be effective, says Dr. Briner.

Runners with EIA may be prescribed a fast-acting medication (an albuterol inhaler is the most common) to relax muscles around the airways. The inhaler can be used before exercise to prevent symptoms for four hours; longer-acting options are also available.

Lifestyle adjustments can also help ease respiratory conditions. Breathing in and out of your nose—rather than your mouth--allows air to be warmed and humidified before it reaches your airways, which can prevent an attack. Wearing a face mask in cold conditions also warms the air you inhale.

Because sudden bursts of activity are more likely to provoke EIA than continuous efforts, keeping a steady pace could help you avoid an attack.

Also, chose your environment wisely: Steering clear of flowery fields or overhanging trees can provide relief. (Since airborne pollen counts are highest between 6 a.m. and 10 a.m., try running later in the day.) If you're sensitive to pollution, train during non?rush hour periods and seek out paths and trails. But if you can't avoid your triggers, or if the air is particularly cold and dry, consider hitting the treadmill.

See your doctor if respiratory issues are interfering with your running. With treatment, you can run—and run well. Just ask a chronic asthma sufferer who happens to own a marathon world record—Paula Radcliffe.